title: A tool to determine financial impact of adverse events in health care: healthcare quality calculator.
abstract: OBJECTIVE
  Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin.
  
  
  METHODS
  Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement.
  
  
  RESULTS
  The Healthcare Quality Calculator (HQCal) compares payment, cost, and profit/loss for patients with and without poor outcomes or quality issues. Cost and payment information for groups with and without quality issues are used by the HQCal to calculate profit or loss. Importantly, institution-specific payment and cost data are used to calculate financial impact and attributable cost associated with poor patient outcomes, adverse events, or quality issues. Because future cost and reimbursement changes can be forecast, the HQCal incorporates a forward-looking component. The flexibility of the HQCal was demonstrated using surgical site infections after abdominal surgery and postoperative surgical airway complications.
  
  
  CONCLUSIONS
  The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.
authors.affiliation: From the *Yale University, Department of Surgery, Division of Otolaryngology/ENT, New Haven, CT; †Yale University, School of Medicine, Department of Psychiatry, New Haven, CT; ‡Vanderbilt University, Nashville, TN; §Life Point Hospitals, Carthage, TN; ¶Health Information Associates Inc., Pawley's Island, SC; ∥Interactive Strategy, IASIS Healthcare, Franklin, TN; and #Hospital Quality Institute, California Hospital Association, Sacramento, CA.
authors.forename: Wendell G
authors.initials: WG
authors.lastname: Yarbrough
authors.forename: Andrew
authors.initials: A
authors.lastname: Sewell
authors.forename: Erin
authors.initials: E
authors.lastname: Tickle
authors.forename: Eric
authors.initials: E
authors.lastname: Rhinehardt
authors.forename: Rod
authors.initials: R
authors.lastname: Harkleroad
authors.forename: Marc
authors.initials: M
authors.lastname: Bennett
authors.forename: Deborah
authors.initials: D
authors.lastname: Johnson
authors.forename: Li
authors.initials: L
authors.lastname: Wen
authors.forename: Matthew
authors.initials: M
authors.lastname: Pfeiffer
authors.forename: Manny
authors.initials: M
authors.lastname: Benegas
authors.forename: Julie
authors.initials: J
authors.lastname: Morath
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D058996:Quality Improvement / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*